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Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in
Olav W Nielsen1, Ahmad Sajadieh2, Muhammad Sabbah2
1From Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Copenhagen NV, Denmark (O.W.N., A.S., M.S., A.M.G.); Department of Internal Medicine, Holbæk sygehus, Holbæk and Center of individualized medicine in arterial diseases, Odense University Hospital, Odense C, Denmark (M.H.O.); Research Unit, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Cardiology, Universitätsklinikum Rostock, Rostock, Germany (C.A.N.); Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (Y.A.K.); Oslo University Hospital, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo, Norway (T.R.P., K.W.); Heart Health Group, Malmö, Sweden (R.W.). own@dadlnet.dk.
Background:
Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal.
Methods:
A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate.
Results:
The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP <120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure <50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039).
Conclusions:
Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
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